Pharmaceuticals in Our Water: A New Threat to Public
Health?

FACTS TO ACT ON FROM WOMEN AND
HEALTH PROTECTION

Written
by Sharon Batt in collaboration with Women and Health
ProtectionOctober 2004

Over the past decade, researchers have been detecting trace amounts of pharmaceutical
products in Canada's lakes, rivers, streams and tap water. Other chemical
ingredients, from cosmetics, toiletries, food additives and veterinary drugs,
have also been found. As a group, these chemicals have been dubbed "PPCPs" (pharmaceuticals
and personal care products). Even though the amounts detected are minute, scientists
and policy makers have begun to worry about possible harm to human health and
the environment.

This fact sheet summarizes what is known about this new health and environmental
concern. It also describes what individuals, governments and industry can do
to reverse the threat these products pose to our health and to the environment.

How Do PPCPs Get Into Our Water?

Here are some of the ways PPCPs enter the environment:

We flush unused medications down the toilet or sink.

We rinse soaps, shampoos and cosmetics down the drain when we bathe.

Between 50% and 90% of the active ingredients in medications are not absorbed
by our bodies – we excrete them into the sewage system.

Drug residues leach from the deceased into cemeteries and groundwater.

Farm
animals excrete veterinary drugs, including hormones and antibiotics, into fields
where they run off into lakes and streams

What About Those "Convenient" Patches
and Rings?

Contraceptive hormonal patches, manufactured by Janssen-Ortho under the brand
name Evra, have been promoted for their convenience. But the used patches contain
large amounts of a persistent, synthetic hormone that can
feminize male fish. Instructions say to fold them in half and discard in
the garbage after use, but the hormone can still leach into the environment. Dr.
Joakim Larsson, a Swedish endocrinologist who has researched the patches,
questions whether they should be sold at all since birth control pills are more
environmentally friendly. A new product making its appearance on the Canadian
market is the NuvaRing, a contraceptive ring manufactured by Organon. The ring,
on disposal, contains 1/3 more estrogen than a month's worth of discarded
patches, and up to 6 times as much hormone as a month's supply of birth
control pills. The Canadian drug approval process has, to date, included no review
of safe disposal requirements and no environmental impact assessment component.
Proposed new regulations are still several years from becoming law and current
regulations do not deal adequately with pharmaceutical products. Pharmaceutical
companies appear to adjust their practices, and information to consumers, according
to the regulations in each country. If Canada's regulations are less demanding
than those of the US and Europe, manufacturers may well apply lower standards
in the Canadian market.

Tests on water in North America have found trace amounts of antibiotics,
painkillers, anti-inflammatories, hormones, tranquilizers, chemotherapy drugs
and drugs used to treat epilepsy and blood cholesterol. A family of chemicals
called phthalates, found in many cosmetics, perfumes and hair products, has also
been detected. Some of the substances (e.g., anti-epileptic drugs) persist in
the environment; others are "pseudo-persistent" -- they break down
but are continually replaced because of widespread use.

Small Amounts Can Have Large Effects

The concentrations of these chemicals detected in water are minute, typically
between 20 parts per billion (ppb) and less than one part per trillion (ppt)
for each substance. But drugs are designed to have an effect in small quantities
and small amounts of different chemicals can add up or interact. We are exposed
to a mix of PPCPs on a daily basis, throughout our lives. The substances and
quantities will vary depending on where we live; each community has its own "chemical
soup". Many drug compounds dissolve in water but about 30 per cent dissolve
only in fat. This enables them to enter cells and move up food chains to become
more concentrated. Another concern is that, as a society, we are using more drugs
than ever before, setting the stage for increased contamination over time.

Deformities in the reproductive systems of fish and frogs show that these chemicals
are not harmless. Risks to humans are not known, but could include resistance
to antibiotics and the disruption of endocrine (i.e., hormonal) systems. Recent
research shows that humans and other forms of life have "windows of vulnerability",
times when exposure to very small amounts of toxic chemicals can be harmful.
A developing fetus, an infant, or a person with a compromised immune system would
typically be at more risk than a healthy adult.

"An Ounce of Prevention ... "

History shows we need to pay attention to early warning signs if we are
to prevent problems to our health and the environment. This is the basis for
a policy approach called the "precautionary
principle". When we suspect harm is being done but the scientific evidence
is still not conclusive, the precautionary principle directs us to act to prevent
the possible harm. Marine life deformities tell us PPCPs have already affected
the ecosystem on which we depend. We need to act now, to reverse these problems
and to prevent others.

Prevention should be our first line of defence against PPCPs. We can begin immediately
with programs to reduce over-use and inappropriate use of pharmaceuticals and
other PPCPs and by disposing s afely of unused products. These precautions are
more economical and ecological than trying to extract PPCPs from the water after
the fact. Improved municipal filter systems and redesigned products, while necessary,
are long-term, costly approaches.

Is the Government Protecting Us?

The Canadian government has begun to look at the problem of PPCPs under
a program called the Environmental
Impact Initiative. This program includes research, public education, and
the introduction of environmental assessment regulations (EAR). But the development
of regulations is proceeding at a snail's pace and new regulatory requirements
are unlikely to take effect for several years. In addition to speeding up the
enactment of regulations, Women and Health Protection believes the federal government
should broaden its program from narrow risk assessment to a holistic "green
pharmacy" approach. This would include an emphasis on prevention, through
reduced use of drugs and other PPCPs. Drug use can be reduced by promoting better
nutrition for disease prevention, increasing the use of non-polluting complementary
and alternative approaches to treatment, enforcing Canada's ban on prescription
drug advertising, and providing unbiased, publicly funded information on prescription
drugs. We have also urged the government to recognize the role of gender in its
policy approaches (see "Women and PPCPs", below).

At the moment, only British Columbia, Alberta and Saskatchewan have comprehensive
programs that encourage consumers to return unused drugs to pharmacies. Other
provinces should follow suit. The
National Association of Pharmacy Regulatory Authorities (NAPRA) has shown
leadership on this issue, but in order to succeed, programs need support from
industry groups, medical associations and federal and provincial governments.

Women and PPCPs

Women have a particularly strong connection to PPCPs. Because of cultural
influences, women are the family members most often responsible for health, including
the purchase of drugs and food, food preparation, family hygiene, care of sick
family members and disposal of home-use products. A
survey of Canadians found more women than men flushed unwanted drugs down
the toilet or sink. This probably reflects the responsibility women take for
children's safety in the home, rather than a disregard for the environment.
In fact, the same survey found that more women than men are interested in learning
how to dispose of drugs safely and are willing to go out of their way to do so.

Many drugs are prescribed more often to women than to men (e.g., anti-depressants);
others are gender-specific (e.g., birth control pills, menopausal hormone therapy).
Drug company ad campaigns often target women to expand the use of existing drugs,
as in the promotion of anti-depressants for "mood disorders".

Women are the main users of cosmetics, perfumes and hair products. Synthetic
musk fragrances from perfumes and other toiletries have been detected in drinking
water. So have phthalates, a family of industrial chemicals used in cosmetics
and linked in animal studies to permanent birth defects in the male reproductive
system.

Biologically, women have different life cycle vulnerabilities to chemicals
than men. Pregnancy is the most obvious example. A woman's exposure to
minute quantities of certain chemicals while she is pregnant can harm the developing
fetus. Such exposure at a critical time in the fetal growth cycle can cause deformities,
cancer or subtle effects on a child's ability to learn. Some health specialists
believe no dose of synthetic hormones is safe for the developing embryo and fetus.

Women also experience adverse reactions to drugs more often than men. This
difference is only in part because women use more drugs than men. A US
government report concludes that physiological differences, such as smaller
average body size and differences in metabolism, may make women more susceptible
than men to some drug-related health risks.

What You Can Do

Reduce Use

Eliminate any unnecessary use of toiletries, cosmetics and drugs.

If you are using a contraceptive patch, switch to contraceptive pills, a
more environmentally friendly choice.

Only purchase cosmetics that are phthalate-free (see "Skin
Deep: A Safety Assessment of Ingredients in Personal Care Products" for
a list of tested brand name products). Contact the manufacturer of any cosmetics
you use regularly and ask them to publicly pledge to remove all chemicals linked
to cancer and birth defects from their products, with labelling of all product
ingredients as an interim measure.

If you eat meat, eat organic to reduce your intake of hormones and antibiotics
and to support the green livestock and poultry industries.

Dispose Safely

Never dispose of unused and expired medications in the sink, toilet or garbage.

Return unused and expired prescription and over-the-counter drugs to your
pharmacist. Ask your pharmacist to ensure proper disposal. Ask your pharmacist
and prescribing physician to educate consumers/patients, in their own printed
matter and verbally, about proper disposal of unused drugs.

Take Action

If your province does not have an organized medications take-back program,
contact the provincial pharmacy regulatory agency, the provincial medical association,
your provincial Ministers of the Environment and Health and the manufacturer
of any drugs you take regularly. Urge them to collaborate on a take-back and
safe-disposal program.

Call your public works department and ask if your municipality includes
discarded pharmaceuticals in its household hazardous waste program. Question
Environment Canada, Health Canada and your provincial Ministries of the Environment
and Health about why more stringent precautions for disposal are not in place.

Contact Janssen-Ortho, the Canadian manufacturer of the patch Evra,
(Tel: 1-866-848-3872) and insist that the product be labelled with instructions
to return used patches to a pharmacy for disposal.

Contact Health Canada's Environmental Impact Initiative (Tel: 1-888-492-1104
or e-mail ear-ree@hc-sc.gc.ca) and the
manufacturers of drugs you use to insist on federally mandated drug labelling
that tells consumers how to dispose of unused drugs. Demand action on proposed
regulations to eliminate PPCPs with potentially harmful ingredients that contaminate
the environment. Demand immediate labelling as an interim measure.